<!DOCTYPE html>
<html lang="en">
<head>
	<link href="images/5.icon" rel="icon" type="image/x-icon" />
	<meta charset="UTF-8">
	<title>预约</title>
	<style type="text/css">
	
		h4{
			margin-left:440px ;
		}
		body{
		     	background-color: whitesmoke
		     }
	</style>
</head>
<body> <!-- pink 御用  拼克 -->
	<h4 style="color: #0005; font-size:25px;">预约人信息</h4>
	<table width="600" border="0" cellspacing="0" cellpadding="0" align="center">
		
		<tr height="60">
			<td>姓名：</td>
			<td><input type="text" value=""  placeholder="请填入姓名"/></td>
		</tr>
		<tr height="60">
			<td>邮箱：</td>
			<td><input type="text" value=""placeholder="请填入邮箱" /></td>
		</tr>
		<tr height="60">
			<td>身份证号：</td>
			<td><input type="text" value="" placeholder="请填入身份证号"/></td>
		</tr>
		<tr height="60">
			<td>婚姻状况：</td>
			<td style="color: blue;">
				已婚 <input type="radio"  name="sex"/>  
				未婚<input type="radio" name="sex"  /> 
				
			</td>
		<tr height="60">
			<td>年龄</td>
			<td>
				<select name="" id="">
					 <option value="">选择套餐</option>  <!-- option选项 -->
					 <option value="">套餐一</option>  <!-- option选项 -->
					 <option value="">套餐二</option>  <!-- option选项 -->
					 <option value="">套餐三</option>  <!-- option选项 -->
					 <option value="">套餐四</option>  <!-- option选项 -->
					 <option value="">套餐五</option>  <!-- option选项 -->
				</select>
				

			</td>
		</tr>
		<tr height="60">
			<td>日期选择：</td>
			<td><input type="text" value="" placeholder="请选择日期"/></td>
		</tr>
		<tr height="60">
			<td><input type="submit" value="立即提交"></td>
			<td><input type="reset" value="重置" /></td>

		
			
		
		
	</table>
</body>
</html>